A 68-year-old man with metastatic extramammmary Paget carcinoma was treated with intravenous drip infusion of docetaxel. One month after completion of the first course of docetaxel, coarse brown network along the superficial veins of the anterior forearm developed at docetaxel injection site. The pigmentation spread proximally after each course of treatment.

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A 33-year-old Japanese woman consulted our hospital with red papules on her face. Suspecting rosacea, we treated her with oral minocycline at 100mg per day. However, the facial lesion gradually developed into a butterfly rash, and she had repeated oral ulcers. Histologically, liquefaction degeneration was observed in the epidermal basal layer as well as in the epithelium of the hair follicles. Laboratory data showed leukocytopenia, hypocomplementemia and high titer antinuclear antibodies. According to the American Rheumatism Association (ARA) criteria, she was diagnosed with SLE. Treatment with prednisolone (30mg/day), improved skin eruption and laboratory data.

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The patient was a 50-year-old male who had poorly controlled diabetes mellitus. The redness and swelling of the left foot progressed rapidly, and he was admitted to our hospital. An x-ray examination revealed subcutaneous gas formation in the left foot. Culture of the pus from the left foot was positive for Streptococcus and negative for Clostridium. Immediately, incision and drainage with extensive debridement of necrotic tissue were performed. About 2 months later, gangrene and the wound healed with granulation and scarring.

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We report five cases of cryoglobulinemic purpura associated with hepatitis C. Case 1 is 64-year-old female. Case 2 is 65-year-old female. Case 3 is 65-year-old female. Case 4 is 78-year-old female. Case 5 is 89-year-old male. The purpuric lesions, rice to soybean sized and partly palpable, were scattered on their legs. All patients complained itchy sensation. On blood examination, serum complements decreased in all cases. Serum rhumatoid factor were recognized in four cases. Hematuria and proteinuria were detected in two cases. Biopsy specimens from three cases showed leukocytoclastic vasculitis in upper dermis. Treatment with topical corticosteroids, oral anti-histamines and rests were effective but the skin lesions frequently recurred after standing work for a long time.

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We report two sisters with basal cell nevus syndrome (BCNS).
Case 1 : 26-year-old woman (elder sister). Case 2 : 24-year-old woman (younger sister). They had family histories with their mother and grandfather. Both sisters had multiple jaw cysts, palmar pits, calcification of falx cerebri and syndactyly (bilateralII-IIItoes). Elder sister had multiple basal cell carcinomas on her upper back and head, but younger sister had only melanocytic naevi. According to the diagnostic criteria of Evans, both their diseases were diagnosed as BCNS.
We compared the Japanese literatures with the foreign literatures about major manifestations and frequencies of their findings in BCNS.

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A 64-year-old man presented for evaluation and treatment of lesions on his maxilla and left nasal foramen for 10 days and 2 years, respectively. On initial examination, there were light brown nodules on the maxilla (10 mm in diameter) and on the left nasal foramen (5 mm in diameter). Histopathologically, the tumor had mamilliform projection, and was composed of irregular-sized lobules. The center of the lobules consisted of foamy sebocyte-like cells and the periphery of the lobules had basaloid cells which had nuclei with rich chromation particles. The tumor was diagnosed as sebaceoma. The patient had complicated with rectum cancer and bladder cancer. Therefore, we diagnosed the patient as Muir-Torre syndrome.

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A skin tumor in the pubic area of an 82-year-old man that had been symptomless to the previous 10 years slowly enlarged. Initially, it appeared as an elastic, hard nodule with purplish dark brown ulceration in its center, and measured 15×20 mm and extended to the penis. It was completely excised because it was suspected to be nodular basal cell carcinoma(BCC). Histopathology confirmed it to be a BCC. Six months after the operation, there were no signs of recurrence.
In our dermatology clinic, between 1990 and 2005, there were 52 cases of BCC, of which only the present cases occurred on the external genitals.

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A 60 year-old woman presenting with skin metastasis from renal carcinoma is reported.
Eleven years ago, she was diagnosed as right renal carcinoma, subsequently metastasis to the left kidney, lungs, brain, and pancreas were founded. She was treated then with immunotherapy, chemotherapy, and radiotherapy.
At her first visit to our hospital, she presented with a red firm skin nodule on the head. Histopathological studies revealed dermal nests consisting of atypical cells of non-cutaneous origin, similar to clear cell carcinoma of the kidney. She died about 10 months after the appearance of the skin tumor.
Skin metasitasis of the renal carcinoma is rare, and when it appears, the prognosis is often poor.

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A 75-year-old female patient was referred to our clinic because of a rapidly growing tumor on the middle chest. A tumor had been resected 20 years ago. Two years after the operation the tumor had recurred and enlarged grew to the present size, 7cm in diameter. Histopathologically, spindle shaped cells with nuclear atypia and bundle structure were observed on HE staining. Immunohistochemistry revealed positive staining for vimentin and S-100 protein. Diagnosis of malignant schwannoma was made. The patient has no personal and family history of von-Recklinghausen’s disease. Eight months after resection, a metastasis was found in right axillar lymph node.

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14 cases of tinea corporis, blackdot ring worm and Kerion celsi in the same Judo club (except 1 girl) caused by T.tonsurans are reported. Their ages are from 7 to 13 years old. They are treated by antifungal ointment only. But gradually their symptoms exacerbated and then T.tonsurans infections soon spread in the club members. Direct examination of the scaly erythema revealed hyphae and hair examination revealed endothrix with numerous large spores. Culture in DTM media yielded yellowish-brown powdery colonies. The colonies of 7 out of 14 cases were determined T.tonsurans by PCR-RFLP analysis of ribosomal DNA regions due to T.tonsurans by Prof. Mochizuki. T.tonsurans made endothrix infection within 14 days after the penetration in the stratum corneum. Protect for expansion of T.tonsurans infection is important problem. Before made endothrix, early orally antifungal administration is most necessary .

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Infection with T.tonsurans often occurs among judo participants in Japan. As a result, guidelines for mass screening using a hairbrush test have been formulated for detecting and treating asymptomatic patients infected with ringworm of the scalp. However, we often experience cases for which we are unable to make a diagnosis in accordance with the guidelines. Thus, difficulties can occur when formulating treatment policy and giving lifestyle guidance, especially when the hairbrush test results and clinical findings are not in accordance with each other. Herein, we report 3 junior and senior-high school students with T.tonsurans infection who belonged to judo clubs in Ishikawa Prefecture, Their diagnosis was difficult to make, as the hairbrush test results and clinical courses did not match the guidelines. A hairbrush test is useful for mass screening to detect T.tonsurans infections. However, since persistent and intractable cases are often encountered, it is proposed that the treatment policy should be formed not only from the results of a single hairbrush test, but also based on the following clinical course.

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We report a case with bite by an adult female Haemaphysalis fiava, which has rarely been reported in the Kinki district, and an extremely rare case with bite by an adult male Haemaphysalis longicornis.
The first patient, a 2-year-old male, went for camping at Tozugawa-mura in Nara Prefecture. One week later, a crust like insect was noted on the scalp. He removed it from the scalp. Subsequently, the insect was identified as an adult female tick, Haemaphysalis fiava. The second patient, a 64-year-old man, went for agricultural work ing in the fields at Hyotanyama in Higashiosaka City. One week later, he visited our hospital for the treatment of seborrheic keratosis on the precordial region. In the treatment with caebon dioxide laser, a doctor found a tick biting on the skin above the left nipple and identified it as an adult male tick, Haemaphysalis longicornis. At the time of their examinations, their skin containing the bite was excised so that the trophy of the ticks might not remain in the wound. Clinical case of bites by larval or female adult ticks, but not by male adult ticks have been documented.

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Pyogenic granuloma is a common, benign, vascular tumor that typically presents as a polypoid mass. Various treatments such as electrodesication, laser therapy, and surgical excision have been reported and shown to have excellent results. However, preferable sites of PG include the fingers and the face that may be cosmetically and anatomically difficult to treat with these invasive methods and the majority of pyogenic granuloma that occurs in children older than 1 year is also difficult to treat with them. We describe “ligation therapy”, which is a simple, minimally invasive procedure, and this technique can be easily performed for these difficult cases. We also believe that this technique be considered as the first choice of treatment for the pedunculated type of pyogenic granuloma

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We investigated the efficacy of the cotton-swab insertion method which involves inserting a cotton-swab under the nail plate of the inflamed ingrown nail in a series of 49 patients treated at Osaka City General Hospital or Osaka City Juso Hospital between 2002 and 2005. We separated the offending nail edge from the adjacent soft tissue by inserting a small piece of cotton-swab under the nail plate in order to achieve immediate relief of inflammation and facilitate successful nail growth, so that its lateral margin would not impinge on the soft tissue of the lateral nail fold. Seven of 9 stage I (mild) cases, 29 of 33 Stage II (moderate) cases, 5 of 7 Stage III (severe) cases showed moderate or marked improvement after the above treatment. The present study demonstrated that conservative treatment by inserting a cotton-swab, was efficient for Stage I, II and even Stage III cases of inflamed ingrown nails.

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Epstein-Barr virus (EBV) is a human oncogenic herpesvirus. Recent studies suggest that NK/T cell lymphocytosis associated with EBV infection often shows characteristic cutaneous manifestations such as ‘hydroa vacciniforme’ or ‘hypersensitivity to mosquito bites’. In this report, we described pathogenic roles of latent or lytic infection of EBV to explain induction mechanism of these cutaneous manifestations.

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Bilateral wedge resection or phenol matricectomy for ingrown toenail of one toe can induce severe nail deformity several years later, because the function of the nail plate that protects the underlying tissues from upward pressure is lost.
Recommended procedures for ingrown toenail are as follows: the shape memory alloy method, super elastic wire method, VHO method, and formable acrylic treatment (sculptured nail method), decide on a case by case basis. The sculptured nail method for ingrowing toenail is used for severe cases in degree.

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Recently, foot care has gained much attention in the medical, social welfare, nursing-care and beauty society in Japan. In Federal Republic of Germany, “Podologie” which is composed of foot care specific technique and study has been established. Those who learned the required technique as well as theory and then passed the examination are qualified as “Podologe” by the German government. I am going to introduce the actual job of Podologie and some techniques in Germany to you.

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In my clinic, the VHO-Osthold-Spange was started, during a little less than three years, the correction of the nail of 450 more toes was treated, the good result has been acquired, and the example of representation was shown. It is possible not to cause trouble to the pain or everyday life like a surgery treatment, but to remove a pain rapidly, and moreover, this therapy is trustworthier than the conventional conservative treatment, and is an outstanding way which does not need to perform frequent exchange. By ingrown nail and incurvated nail without an inflammatory symptom, it is about 10,000 ability. However, although it could respond by using the gutter method, cryosurgery, etc. together to the thing accompanied by a granulation tissue, there was a case of being difficult.

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From January 2002 to February 2006, 249 patients with ingrown and pincer nail were treated. Among them, 6, 78, 101 and 82 patients were treated with tapering, gutter method, orthonyxy with ultraelastic steel wire and virtuos human orthonyxy, respectively.

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